►
Description
House Insurance Committee- March 22, 2022- House Hearing Room 1
A
B
A
A
C
Thank
you,
chairman
kumar
tennessee
has
a
population
of
citizens
who
are
eligible
for
both
medicare
and
medicaid.
We
might
call
them
dual
eligibles.
They
currently
have
six
different
options
through
which
to
receive
their
medicare
and
their
medicaid.
One
of
these
six
options
is
to
receive
it
through
a
d
snip
plan.
That's
an
abbreviation
and
what
it
stands
for
is
dual
eligible's
special
needs
plan.
C
C
The
other
three
d,
snip
providers,
would
then
no
longer
have
a
contract
with
tenncare,
which
means
that
these
dual
eligible
folks
in
tennessee
would
have
to
do
something.
Different
they'd
have
to
pick
a
different
d.
Snip
plan
or
they'd
have
to
pick
one
of
the
other
five
medicare
options.
So
what
this
bill
does
is
two
things.
There's
two
parts,
a
first
part
and
a
second
part
in
the
first
part
of
the
bill.
C
A
D
D
D
A
C
The
bill
says
that
for
this
next
fiscal
year,
the
fourth
mco
would
be
the
one
that
applied
through
the
rfp.
After
that,
when
there
is
time
for
more
applicants
to
apply
through
the
process,
then
there
will
be
more
to
pick
from
okay,
so
this
would
this
would
I
guess
this
bill
would
sort
of
govern
the
next
year,
but
not
necessarily
thereafter.
C
D
C
Doesn't
specify
what
we
would
do
in
future
years?
It
does
call
for
additional
mcos.
There
was
only
one
additional
applicant
in
the
last
rfp,
and
so
this
bill
to
increase
the
number
of
mcos
would
would
specify
that
that's
the
one
that
needs
to
be
added
for
the
short
term,
but
in
the
long
term
the
goal
would
be
to
have
more
applicants
involved
competitively
in
the
process
so
that
there
could
not
only
be
more
mcos
but
there'd
be
more
applicants
to
choose
from.
D
C
C
We
only
have
three:
we've
had
three
for
the
past
20
years,
three
have
been
approved
through
this
most
recent
rfp
by
tenncare
to
have
their
contracts
renewed,
every
other
state
that
has
the
size
of
medicaid
population
that
we
have
has
more
mcos
I'll,
give
a
couple
of
examples
in
kentucky
and
south
carolina
which
have
smaller
populations
and
fewer
enrollees.
They
each
have
five
mcos
and
then
there's
other
states
that
have
more
people
that
have
a
whole
lot
more
mcos
like
texas
and
florida
each
have
15
or
more.
So.
C
The
rationale
behind
this
bill
is
that
tennessee
ranks
relatively
low
in
health
care.
We
want
to
find
a
way
to
move
that
up.
We
think
one
possible
approach
would
be
to
get
more
competition
among
these
mcos
and
one
way
to
do
that
would
be
to
get
more
of
them
involved
in
the
process.
So
this
is
a
way
of
adding
a
fourth
mco.
It's
not
really
possible
to
add
a
fifth
mco
from
the
most
recent
rfp,
because
only
four
applied,
but
there's
lots
of
different
new
elements
and
dimensions
to
health
care.
E
E
And
so,
mr
chairman,
is
that
okay,
fine
yeah,
so
your
intent
is
to
make
sure
that
if
there
is
another
mco
out
there,
that
could
provide
this
this.
These
benefits
to
the
people
of
tennessee
that
now
we
have
more
options
to
provide
more
services
to
more
people
and
make
competition
come
into
this,
where
the
ones
that
provide
it
best,
people
will
gravitate
to
to
get
those
services
correct.
That's.
E
And
so
with
that
rational
thinking,
you
have
right
there
as
people
start
to
realize
that
tennessee
is
looking
for
more
people
to
bid
on
this
to
create
more
competition
and
more
opportunity
for
their
citizens.
Your
bill
doesn't
limit
that
at
all
where
we
could
have
four
five
six,
seven
mcos
that
could
be
providing
the
service
to
tennesseans.
Is
that
correct.
F
Yeah,
thank
you,
mr
chairman,
and
you
know
a
part
of
me
when
no,
no
all
of
me
agrees
with
what
representative
hodges
said.
My
only
my
only
qualm
about
this
is,
I
think,
we're
going
to
put
in
turmoil
what
25
000
tennesseans
by
making
this
change
right
now.
So
I
think
the
best
thing
to
do
is:
let's
pause
for
this
one
year
that
you're
saying
I
don't
like
us
getting
involved
every
time
someone
loses
a
bid,
but
to
correct.
So
we
don't
put
these
vulnerable
people,
these
25
000
in
a
quandary
right
here.
F
A
G
Thank
you,
members
and
committee
ashley
reed
with
the
division
of
tenncare,
and
I
have
drew
stanievsky
with
me
as
well.
There
are
questions
this
bill,
as
amended
requires
tenncare
to
do
two
things.
First,
we
must
renew
expiring
contracts
with
any
medicare
dual
eligible
special
needs
plan.
What
we
call
d-snips
indefinitely
until
the
general
assembly
adopts
a
resolution
permitting
non-renewal.
G
G
The
requirement
to
continue
to
contract
with
all
existing
dsnips
would
require
tencare
to
contract
with
existing
vendors
simply
because
they
had
a
contract.
Previously,
we
do
not
believe
this
is
effective.
State
policy,
as
written
tencare,
would
not
be
able
to
enforce
the
contract
based
on
performance
or
improve
the
experience
of
dual
members
by
aligning
their
two
healthcare
programs.
G
Moreover,
it
would
require
tencare
to
spend
additional
funds
through
increased
administrative
costs
from
more
mcos,
as
well
as
increased
capitation
payments
to
those
mcos.
Lastly,
requiring
10
care
to
contract
with
a
specific
bidder
from
a
competitive
procurement
enables
losing
bidders
to
bypass
the
competitive
procurement
process
and
will
set
a
precedent
for
future
procurements.
That
vendors
will
likely
attempt
to
repeat
happy
to
answer
any
questions.
D
H
H
Thank
you
for
the
question.
It's
a
great
question.
I
think
for
tin
care
we're
a
steadfast
believer
that
three
mcos
is
the
right
number
for
this
state.
I
think
our
biggest
period
of
success
has
been
the
last
13
years
and
that's
the
last
13
years
have
been
with
three
mcos.
It's
really
true
from
both
a
cost-effective
standpoint,
as
well
as
a
quality
standpoint.
If
you
look
at
our
trend,
those
last
13
years,
in
particular
we're
averaging
about
2.4
percent,
which
is
very
low
slower
than
the
other
states
that
has
been
have
been
mentioned.
H
If
you
look
at
our
trend,
let's
say
the
last:
ten
years
before
we
moved
to
three
mcos
in
tenncare,
we
were
averaging
about
eight
mcos.
Several
of
those
years
include
a
period
with
six
mcos.
Our
trend
was
at
6.5
percent,
so
that
that
gap
is
a
lot
of
money
right.
It's
a
lot
of
extra
money
going
out
the
door.
The
other
thing
that
I
would
say
too
is
this
will
mean
less
cost
to
tin
care
because
we're
not
standing
up
an
additional
mco.
H
So,
in
addition
to
getting
sort
of
a
better
deal
on
cap
rates,
it's
less
admin
costs.
We
have
to
pay
to
mcos,
it's
less
staffing
and
admin
infrastructure
for
10
care
to
have
to
monitor
additional
mcos.
So
I
think
we've
seen
in
our
history.
This
is
the
right
number
for
us
and
I
think
the
the
results
fiscally
and
quality.
I
think,
bear
that
out.
F
H
A
good
question,
I
think
what
was
in
1994,
we
started
with
12.
and
so
we've
not
a
history
in
every
moment
of
tin
care,
but
I
believe
we've
gone
kind
of
stepped
down
from
there
as
we've
realized.
Less
mcos
has
been
a
better
deal
for
the
state,
and
that
has
also
coincided
with
the
mcs
going
statewide,
so
we
had
12
mcos
at
the
beginning,
they're
also
very
regional,
and
so
it's
been
a
trend
over
time.
Our
progression
over
time
from
12,
very
regional
mcos.
To
now
three
statewide
ngos.
F
Yeah
and-
and
I
rem-
I
remember
a
time
where
you
know
the
mcos-
it
got
so
ridiculous
of
them
recruiting
membership,
even
with
cell
phones
back
in
the
day.
But
you
know
we
we're
hearing
all
these
other
states
of
simula
similar
population
have,
you
know,
double
the
choice
that
we
seem
to
have
and
and
that's
my
only
concern
that
we're
narrowing
it
down.
How
many
did
we
cut?
How
many
did
we
have
before
the
bid
went
out.
I
F
H
A
H
Did
you
say,
difficulties
with
enrollment,
mr
chairman,
or
just
difficulty
with
accessing
providers?
Right?
No,
we
haven't
in
fact,
there's
a
a
survey
that
is
done
every
year
by
the
university
of
tennessee.
It
actually
measures
member
satisfaction
with
the
program
so
really
enrolled
members
who
are
who
are
getting
services
from
mcos
on
ongoing
basis.
For
the
last
13
years,
we've
been
over
90
in
in
member
satisfaction.
H
That
coincides
with
the
fact
that
we've
been
at
three
statewide
mcos
the
last
year
measured
was
2021.
We
were
at
92
percent
overall
satisfaction,
there's
also
a
portion
of
that
where
they
ask
additional
questions
about
seeking
care
and
from
the
the
latest
survey,
two
percent
of
households
reported
seeking
care
from
a
non-tank
care
provider,
because
there
was
not
a
tin
care
provider
in
the
area.
Likewise,
only
two
percent
sought
care
with
a
different
provider
because
they
were
dissatisfied
with
the
quality
of
care.
H
So
we
also
see
that
from
the
provider
perspective
you
know,
we've
got
over
90
percent
of
licensed
physicians
contracted
with
tin
care,
at
least
one
of
the
mcos
86
of
those
providers.
Those
physicians
are
accepting
new
patients,
so
we're
not
seeing
a
large-scale
issue
with
access
or
or
member
choice
issues
I
would
say,
or
dissatisfaction
from
the
members
either.
K
H
H
Well,
it's
not
a
it's,
not
necessarily
a
threshold
score
where,
if
you're
below
that
threshold
you're
automatically
disqualified,
but
certainly
if
you
take
four
or
five
mcos,
you're
you're
being
forced
to
take
an
mco
who
did
not
score
as
well
so
you're
gonna
have
concerns
with
those
mcos
that
scored
lower
getting
bids,
but
it
wouldn't
there's
no
like
absolute
bars
or
floor.
You
have
to
meet
necessarily
to
then
now.
If
someone
scored,
you
know
exceedingly
low.
I
think
it's
within
states
discretion
potentially
to
take
a
second
look
at
that.
H
H
So,
just
using
the
last
two
procurements,
because
they've
been
three,
I
believe
they've
been
three
statewide.
These
are
our
last
two
procurements
are
three
mcos
all
statewide,
this
last
percent.
We
had
four
and
I
I
want
to
say
it
was
a
little
bit
more
in
2013,
maybe
six
or
seven,
but
I'd
have
to
double
check
that
for
you
it
was
more
than
four.
I
know
that.
L
Thank
you
cheer,
lady.
Just
to
answer
your
question.
I've
been
on.
I
started
sitting
on
physical
review
about
2011
and
I
know
they
came
before
us.
I
know
at
least
since
that
time,
so
the
three
since
2011,
I'm
pretty
pretty
sure.
My
question
is
this:
to
my
colleagues
question
earlier:
usually
competition
in
the
market
brings
prices
down,
especially
for
the
consumer.
H
So
I
think,
there's
two
pieces
to
it.
Really,
I
think
number
one
is
the
administrative
cost.
So
no
matter,
if
you
add
an
additional
mco,
you're
you're,
ultimately
going
to
have
to
pay
admin
costs,
that's
required
to
be
included
in
the
capitation
rate
by
actuaries
under
federal
reg,
so
you're
going
to
add
admin
built-in
admin
costs
for
each
additional
mco.
H
I
think
the
other
piece
of
it
is
just
the
more
lives
you
cover,
there's
more
certainty
in
your
risk
pool,
and
so,
if
you're
going
to
take
a
significant
portion
of
lives
away
from
each
mco
they're
going
to
have
less
certainty
and
less
predictability
in
their
risk
pool,
and
so
if
they,
if
that
occurs,
there's
just
more
risk
that
they're
going
to
increase
costs.
I
think
that's
the
reality
situation.
So
if
they
do
that's
going
to
also
put
upward
pressure
on
cap
rates.
L
H
E
You
very
much
so
I'm
just
trying
to
get
my
information
from
what
you're
presenting
is
accurate.
Okay,
so
you're
saying
since
2009,
we
roughly
had
three
mcos
moving
forward
from
there.
Is
that
correct?
Yes,
sir,
and
and
since
2009,
I'm
assuming
you're
telling
me
that
the
population
of
tennessee
hasn't
changed
at
all.
E
I'll
help
you
out,
it
has
so
if,
if
we,
if
we
add
the
fourth
and
I'm
looking
at
a
list
here,
there's
really
there's
no
rhyme
or
reason
to
it
of
how
many
mcos
there
are
california
has
over
20
population
size
right
new
york
has
over
20.
illinois
has
more
than
us.
Iowa
has
more,
I
believe,
chicago
chicago
kentucky
has
more
in
us.
Louisiana
has
more
of
us
there's
no
rhyme
or
reason
to
this.
E
H
E
E
M
H
Thank
you
for
the
the
question
representative,
terry.
I
think
that's
a
little
bit
of
a
complicated
answer,
so
there's
three
overall
components
to
how
an
rfp
gets
scored.
There
is
a
mandatory
section
which
is
essentially
you're
representing
that
you,
you
can
do
or
you're
testing
to
be
able
to
meet
the
rfp
certain
things
that
if
you
can't
you
can't
pass,
you
are
automatically
bypassed
essentially
and
then
there's
two
additional
sections.
H
One
is
the
general
qualifications
which
talks
about
sort
of
your
general
experience,
your
staffing,
those
types
of
things
even
just
sort
of
your
business
structure,
and
then
the
technical
side
is
section
c,
which
is
a
series
of
questions
on
how
you're
going
to
approach
all
the
services
that
are
required
of
you
under
the
contract,
and
so
there
are
a
myriad
of
scores
that
are
baked
into
those
two
sections.
I
don't
know
there's
one
particular
outlier
from
the
overall
scoring
that
we
would
point
to
to
say
that
that's
this
is
the
specific
reason
why
they
lost.
H
M
M
But
from
a
contracting
perspective
is,
is
there
a
difference
in
the
three
mcos
as
to
which
providers
are
willing
to
contract
with
them?
In
other
words,
will
they
be
more
willing
to
contract
with
mcoa,
because
they
may
actually
have
a
little
bit
better
rates
than
mcoc
and
then
well?
You
know
that's
first
question
yeah.
H
Thank
you
for
the
question.
Yes,
so
all
the
msos
are
responsible
for
building
their
networks
and
they
also
negotiate
their
own
contracts.
So
it's
very
possible
you
might
have
a
provider
who's
contracted
with
all
three
or
maybe
just
one
mco,
and
there
may
be.
You
know
a
number
of
reasons
why
the
provider
has
decided
to
do
that.
M
D
Thank
you,
madam
chairman,
and
just
if
you
would
have
had,
if
you
would,
if
this
bid
would
have
been
for
five,
would
would
more.
Is
it
safe
to
assume
that
more
companies
would
have
bid,
because
I
mean
only
four
bid?
I
mean
was
the
assumption
by
by
other
companies
that
that
the
same
three
are
going
to
win.
It.
H
I
thank
you
for
the
question.
I
don't
think
we
know
the
answer
to
that.
I
think
that
if,
if
you
add
additional
mcos
you're,
we've
talked
about
the
fact
that
you're
changing
you're,
changing
the
risk
pool
quite
a
bit
for
the
mcos
and
so
how
they
decide
to
bid
would
be
up
to
them,
but
it's
certainly
a
different
bid.
If
you
have,
we
think
it
changes
the
landscape.
H
If
you
go
to
four
because
now
you're
talking
about
a
totally
different
amount
of
lives
covered,
so
the
mcos
didn't
have
to
make
their
decision
on
whether
or
not
they
think
it's
worth
bidding
and
what
their
risk
situation
is.
I
would
say
two
there's
just
a
math
component
there
right.
If
you
have
five
or
six
or
however
many
there's
more
there's
odds
of
you
or
winning
or
potentially
higher.
So
you
may
decide
it's
worth
bidding
just
based
on
odds.
H
Thank
you
for
the
question
representative
powers.
The
answer
is,
we
would
save
money,
it's
it's.
90
million
in
admin
costs
every
year
that
we
wouldn't
be
paying
it's
just
30
million
state
from
an
I.t
perspective,
so
some
of
that
is
it
cost.
I'm
not.
I'm
not.
You
know.
Adding
mcos
additional
mcos
to
the
to
our
infrastructure
can
cost
money.
If
we
subtract,
I
don't
know
the
answer
to
that.
That's
an
interesting
question.
H
J
J
N
J
N
Thank
you,
madam
chair
members.
This
this
bill
is
very
limited
in
scope
to
complex
rehab
technology,
which
I'm
going
to
say
crt.
So
I
have
to
say
that
going
forward
every
time,
but
it's
it's
defining
code
as
high-end
and
power
and
manual
wheelchairs,
similar
to
the
ones
I'm
sitting
in
now
they
can
run
between
25
and
40
thousand
dollars.
N
N
J
J
J
J
M
J
J
O
Thank
you,
members.
Thank
you,
chair,
lady
members.
One
of
my
favorite
quotes
is
by
abraham
lincoln.
He
said.
If
I
had
eight
hours
to
chop
a
tree,
then
I
spent
six
sharper
than
my
acts,
and
what
this
is
is
attempt
to
cut
some
of
our
costs
when
it
comes
to
health
care
in
our
state
plan.
This
bill
simply
is
asking
tasser
to
conduct
a
study
on
the
effects
of
our
health
insurance
plan
when
it
comes
to
reference-based
pricing
and
if
reference-based
pricing
is
something
that
that
is
feasible
with
our
state
plan.
O
If
many
of
y'all
remember
about
three
years
ago,
I
asked
for
a
task
for
study
when
it
come
to
sexual
trauma,
with
with
with
minors,
that
taskra
study
led
to
legislation
the
following
year
that
we
passed
in
a
majority
up
here,
our
tennessee
health
care
plan.
Many
may
not
realize
it's.
It
exceeds
1.6
billion
1.6
billion,
based
on
the
analysis
that
we
had
conducted.
O
O
If
many
all
remember,
we
did
conduct
a
summer
study
two
years
ago.
What
come
out
of
that
summer
study
is
that
there
are
huge
outliers
in
our
health
care
plan.
Much
of
that,
according
to
fiscal
review,
stated,
this
would
save
the
taxpayers
24.6
million
at
over
19.6
million
the
following
the
following
year.
Some
of
those
varying
outliering
prices,
for
example,
was
the
ct
scan
that
we
uncovered
the
charges
average
charge
of
635
dollars.
2018.
O
O
This
study
can
say
if,
if
we
didn't
go
to
representatives
pricing,
I
do
think
there's
some
potential
of
uncovering
some
of
these
outlying
costs
and
why
they're
so
success
so
excessive,
and
I
think
it
could
help
rein
it
in
thus
sharpen
that
axe
and
save
the
taxpayers
some
money.
So
I'm
just
simply
asking
for
this
study
members.
F
Yeah,
thank
you,
madam
chairlink,
so
so
on
your
study,
you
know
just
say
we're
going
to
have
tasser.
Do
a
study
on
this.
You
know.
Are
you
giving
any
parameters
for
this
because
you've
got
to
have
a
baseline?
Yes,
in
reference
based
pricing,
you
know
most
of
the
time
you
know
from
the
reference
based
pricing.
I've
dealt
with,
it'll
be
medicare
140
of
medicare,
yes,
and
then
you'll
have
stop
loss
to
go
up
to
200
percent
of
medicare.
You
know
your
cost.
That
you're
talking
about
you
know
is
again
referenced
in
baseline
of
medicare.
F
F
You've
got
to
have
some
parameters
because
there's
no
way
for
for
tasser
to
do
this
study
in
a
short
period
of
time,
without
some
parameters
of
what
they're
looking
at
to
accomplish
something.
You
know
they
don't
have
to
study
this
to
understand.
It's
gonna
say
it
would
save
the
state
a
lot
of
money,
but
there's
also
there's
also
disruption
within
reference
based
pricing,
because
you
know
if
you're
xyz
facility
or
xyz
provider,
they
can
say,
I'm
not
accepting
a
hundred
and
forty
percent.
O
F
So
I
mean:
is
the
state
going
to
be
prepared
for
for
that
turmoil
and
you're
going
to
have
our
members,
our
employees,
that
you
know
you,
and
I
aren't
going
to
be
getting
the
letters
from
that
health
care
provider,
saying
we're
turning
you
over
to
the
credit
bureau
or
we're
going
to
sue
you
our
employees
will
be
so
I
mean
it's
a
it's
a
tricky
situation
to
go
there.
Thank
you.
O
I
was
just
going
to
say
no,
but
I
appreciate
representing
mitchell's
point.
I
mean
why
the
400
versus
700
percent
cost
that's
another
example
of
a
huge
outlier.
We
would
never
see
lack
of
transparency
in
the
car
business
in
the
real
estate
business
with
tim
rudd.
We
would
never
see
these
type
of
variables
and
lack
of
transparency
like
we
do
in
in
health
care
costs.
So
back
to
what
represent
mitchell
said.
Why
do
we
have
these
huge
outliers
if
it,
even
if
it
is
an
er
visit
or
other
visits
it?
O
I
I
don't
see
where
there's
anything
I
mean
the
free
market
and
you
mentioned
disruption.
Disruption
is
a
great
thing.
We
got
electric
cars
across
the
the
street
here
with
launch
that
new
cadillac's
out
there
and
sapiki's
district,
the
new
ford
truck
they've
got
a,
I
believe,
a
model
over
there,
so
disruption
in
the
marketplace
has
been
a
great
thing,
whether
it's
cell
phones,
whether
it's
other
technology,
whether
it's
vr
technology,
whether
it's
distance
learning
so
back
to
represent
mitchell's
point.
O
There's
there
are
huge
variables
out
there
when
it
comes
to
health
care
and
that's
exactly
what
I
want
to
come
out
of
this
study,
even
if
they
only
even
if
they
only
move
the
needle
one
percent.
One
percent
of
1.6
billion
dollars
is
what
16
million
curtis
16
million
dollars.
It's
a
lot
of
money,
even
if
we
move
the
needle
one
percent.
So
thank
you.
B
O
And-
and
I
I
mean
I
hate
to
keep
complimenting
representative
mitchell
here,
but
he
he
seems
to
understand
it,
and-
and
I
really
applaud
you,
because
a
lot
of
people
don't
understand
it,
it's
very
confusing.
Basically,
the
definition
represents
pricing
respects
pricing
is
a
healthcare
cost
containment
model
that
limits
what
a
group
healthcare
plan
will
pay
for
certain
high-cost
services,
including
hospital
and
outpatient
facility
charges.
There
are
a
variety
of
reference-based
pricing
strategies
that
employers
can
implement
and
going
back
with
the
davidson
county
representatives
mentioned.
O
You
know,
maybe
that's
legislation
next
year,
if
something
positive
comes
out
of
it
and
I'm
100
positive.
Something
will
that
will
good
will
come
out
of
this.
Out
of
this
study,
I
believe
in
taser,
I
believe
in
the
services
they
offer.
Dr
cliff
lippert
was
very
instrumental
in
helping
us
pass
that
childhood
sexual
trauma
legislation
two
years
ago,
which
originated
by
the
tasser
study.
J
J
Excuse
me:
we
have
a
motion
and
a
second,
and
I
do
believe
this
bill
also
is
traveling.
With
a
I
mean,
has
a
an
amendment
and
hopefully
I
will
get
this
one
right:
zero,
one,
five,
seven,
nine
six!
Is
that
correct,
that's
correct!
Do
I
have
a
motion
and
a
second
all
in
favor
of
attaching
amendment
number
zero,
one,
five,
seven,
nine
six,
please
say
aye
those
opposed.
No!
Q
You,
madam
chair
and
members,
I
want
to
first
off
thank
the
committee
for
working
with
me
on
this
bill
and
subcommittee
and
thank
tenncare
for
helping
us
get
the
language
in
a
position
where
they
could
work
with
us
on
this
bill.
Originally,
this
bill
was
carried
by
senator
lamar
and
she's
asked
me
to
carry
it
through
in
the
house
house.
Bill
1973
is
a
remote
patient
monitoring
bill
and
will
create
a
pilot
program.
Q
This
bill
will
help
create
positive
health
outcomes
for
mothers,
and
babies
in
tennessee
make
it
possible
to
detect
issues
with
mothers
and
babies
before
birth
and
to
reduce
the
number
of
emergency,
c-sections
and
pre-term
deliveries
in
our
states.
Madam
chair,
this
isn't
a
piece
of
legislation
where
we're
attempting
to
find
outcomes.
It's
evidence
we
have
from
other
states
that
we
can
show
that
there
are
better
outcomes
for
mothers
and
babies
and
our
physicians.
Q
According
to
march
of
dimes,
11
of
children
born
in
tennessee
are
premature
and
for
african-american
mothers
it's
raised
to
15
for
mothers
and
who
develop
gestational,
diabetes,
high
blood
pressure
and
other
issues
around
birth.
A
system
of
recording
real-time
data
can
increase
the
success
rate
for
healthy
birth
and
healthy
outcomes
for
the
mother,
and
so,
madam
chair
members,
this
is
a
great
opportunity
for
us
to
help
save
lives
in
the
state
of
tennessee,
and
I
would
appreciate
your
vote
yes
on
this
bill.
Thank
you,
madam
chair
members,.
L
Thank
you
true,
lady
resident
camper.
I
know
correct
me
if
I'm
wrong
on
this.
I
know
like
certain
hospitals
like
down
where
we
live
in
memphis
we've
got
the
bonner
child
hospital
and
they
try
to
have
independent
programs
doing
this
already
with
a
bill
such
as
this
aid
and
help
them
expand.
That
or
do
you
know.
Q
L
J
Q
Q
This
legislation
is
based
on
a
program
currently
being
used
in
memphis
in
our
ems
system,
and
it
makes
sure
that
those
who
need
mental
health
are
taken
to
the
place
where
they
can
best
get
the
services
that
they
need.
This
bill
will
also
allow
for
issues
that
can
be
best
addressed
in
non-emergency
care
facilities,.
L
Thank
you
chairman,
and
if
you
have
two
good
bills,
I
like
I
really
do
like
this
one,
because
a
lot
of
times
when
I,
when
especially
those
mentally
ill
they're,
picked
up
on
the
street,
there's
two
options:
take
them
down
the
local
jail
and
or
to
the
emergency
room,
the
emergency
rooms.
You
know,
then
they
got
to
send
them
on
somewhere
else
with
a
lot
of
expense.
So
this
is
a
third
option,
so
I
think
it's.
This
is
a
as
I
understand
it
is
an
excellent
piece
of
legislation.
I
support
it.
A
A
A
I
Thank
you,
mr
chairman
and
members
of
the
committee.
A
continuous
glucose
monitor,
cgm
lets
patients
see
their
glucose
numbers
continuously
in
real
time
is
updated.
Every
five
minutes
allowing
diabetes
patients
to
make
better
diabetes
treatment
and
management
decisions
with
no
finger
sticks,
continuous
glucose
monitors
or
cgms
are
the
standard
of
care
for
all
patients
on
insulin
therapy,
regardless
of
diabetes
type.
According
to
the
american
diabetes
association,
cgms
give
patients
access
to
their
blood
sugar
throughout
the
day
and
never
have
to
rely
on
lancets
test
strips
or
glucose
monitors
meters.
I
A
clearly
defined
cgm
coverage
policy
within
10
care
will
ensure
all
medical
beneficiaries
will
have
equal
access
to
the
life-saving
benefits
of
cgm
technology.
This
moves
tenncare
more
in
line
with
the
standards
for
other
care
in
the
diabetes
association
requires
currently
cgms
are
available
through
a
through
tencare
as
a
medical
benefit.
As
amended.
This
legislation
would
add
cgms
to
the
state
preferred
drug
list
as
a
pharmacy
benefit.
The
same
way.
Lancets
testing,
strips
and
meters
are
now
covered.
I
Providing
a
more
efficient
and
consumer-friendly
procedure
for
glucose
blood
testing
will
result
in
a
better
standard
of
care
for
patients.
Better
care
will
result
in
fewer
urgent
care
visits,
er
visits
and
hospitalization
hospital
hospitalizations
due
to
comp
complications
from
poor
glucose
levels
and
providing
better
health
outcomes.
I
Cgm
coverage
as
a
pharmacy
benefit
is
becoming
increasingly
common
because
of
the
ability
to
negotiate
supplemental
rebates
and
lower
costs.
The
majority
of
the
commercial
plans
provide
cgm's
as
a
pharmacy
benefit.
More
than
half
of
the
other
states,
medicaid
more
than
half
of
other
states.
Medicaid
programs
cover
cgm
as
a
pharmacy
benefit
members.
A
lot
of
us
know
or
have
not
have
or
know
someone
with
diabetes.
I
I'm
working
with
tenncare,
we
actually
we've
been
talking,
as
we
were
sitting
here,
to
continue
to
work
as
we
move
to.
If
this
passed
this
committee,
as
we
continue
to
work
once
it
gets
to
finance
ways
and
mean
to
continue
to
work
on
the
language,
because
I
think
it's
a
one
or
two
words
that
could
help
reduce
that
even
further.
I
So
I
think
there's
an
opportunity
to
get
it
down
even
further
or
maybe
even
no
cost
it's
just
depending
on.
We
have
to
work
on
the
language
with
10
care
and
we're
still
going
back
and
forth,
and
just
trying
to
make
sure
that
the
bill
has
continues
to
have
the
intent
that
it's
meant
to
have
so
that
people
can
have
this
coverage.
I
And
just
as
a
side
note
and
this
personal
note
about
when
it
comes
to
diabetes
last
thursday,
I
have
a
cousin
he's
about
three
years
older
than
me,
but
we
were
raised
like
brothers
and
because
he
on
the
medicaid
and
he's
doesn't
have
the
the
economic
background
to
get
better
health
care.
His
his
foot
was
amputated.
You
know,
he's
55
years
old,
and
so
this
not
only
helps
me
if
he
had
had
this
early
on
in
his
that
when
he
first
was
diagnosed
with
diabetes
several
years
ago.
A
A
A
We
have
a
motion
and
second
on
the
amendment,
without
objection,
we
are
voting
on
amendment
zero,
one,
five,
eight,
nine
four
going
on
house
bill,
two
one:
zero,
nine,
all
those
in
favor,
please
say
aye
oppose
the
amendment
goes
on
the
bill.
Leader
love.
You
recognize
on
the
mandate
house
bill
2109
thank.
P
You,
mr
chairman,
and
members,
this
piece
of
legislation
brought
to
me
by
now
senator
lamar
thankful
for
that
opportunity.
We've
been
working
with
tenncare
and
with
the
health
department
to
find
a
way
to
include
a
definition
of
doulas
so
that
they
can
be
properly
recognized
for
the
great
work
that
they
do,
and
I
want
to
thank
tenncare
and
the
department
of
health
for
working
with
us
on
this.
P
As
you
see,
the
amendment
simply
says,
doodles
are
medical
professionals
provide
emotional
and
physical
assistance
in
different
aspects
of
reproductive
health
and
provide
additional
support
during
the
prenatal
period,
labor
and
delivery
and
postpartum
coverage,
and
so
this
will
allow
the
department
of
health
to
collaborate
with
tenncare
to
study
existing.
Do
the
certification
programs.
L
P
A
Any
other
questions
well,
thank
you
for
bringing
this.
I
really
think
it's
a
very
needed
effort
in
our
society,
because
child
care
and
the
time
through
pregnancy
and
afterward
are
very
critical,
especially
especially
for
young
parents
but
mamas
and
grandmas
used
to
advise
that
is
not
always
available.
A
A
B
A
Well,
it
has
been
an
honor
and
it
has
been
good
of
the
work
we
have
done
together
and
want.
We
want
to
thank
our
staff,
our
clerk,
our
intern,
ms
savannah,
as
well
as
ms
colleen
in
my
office
and
the
other
staff,
as
well
as
our
attorneys
as
and
our
research
analyst,
they
have
all
been
very
diligent
in
their
work
and
they've
been
very
helpful
and
we
are
grateful
to
them
because
we
can't
really
do
work
without
them.
Am
I
forgetting
something
our
sergeant-at-arms?
Okay?
Well,
you're
gonna
have
to
forgive
me.